Cone-beam Computed Tomography Analysis of the Root Canal Morphology of Mandibular Incisors Using Two Classification Systems in a Spanish Subpopulation: A Cross-Sectional Study.

OBJECTIVE: This study evaluated the root and canal morphology in permanent mandibular incisors teeth using cone-beam computer tomography imaging in a Spanish subpopulation, and compared these findings with ipsilateral (similarity) and contralateral (symmetry) incisors. In addition, the position of canal splitting was measured. METHODS: A total of 229 datasets comprising four mandibular teeth each (n=916 incisors) were analysed using Vertucci and Ahmed et al. classifications, and, the similarity and symmetry were calculated. The distance from the cemento-enamel junction (CEJ), and the most coronal canal divergence was measured (if present). The role of sex was also assessed. The Cochran Q Test, LOGIS PROC in SUDAAN, Chi-square, and Kappa were used for the different comparisons. A p-value of less than 0.05 was considered significant. RESULTS: All incisors were single-rooted and no significant differences regarding root canal morphology were found according to the sex of the subjects included in the database. The most common morphology was Vertucci type I/Ahmed et al. 1MI1(65.3% for central and 66.8% for lateral incisors respectively), followed by type III/1MI1-2-1 (31% for central and 30.6% for lateral incisors). 1.8% of the samples were considered as non-classifiable with Vertucci but were classified with codes using the Ahmed et al. system. Similarity values were 74.7% for the left side, and 74.2% for the right side, whereas symmetry values were 90% for central and 84.3% for lateral incisors. In the presence of divergences, the main (SD) distances from the CEJ were for type II/1MI1-2-1 3.8+-0.8 (centrals) 4.0+-0.7 mm (laterals); for type V/1MI1-2 this value ranged between 6.0+-1.8 and 5.5+-1.5 mm, whereas values for 1MI1-2-3-2-1 were 1.8 and 2.1 mm. No significant differences were found when the position of the most coronal divergence was compared between lateral and central incisors for the different morphologies. CONCLUSION: A high prevalence of Vertucci I/Ahmed et al. 1MI1 configuration was present in mandibular incisors from Spanish individuals. Similarity and symmetry were common, particularly for central incisors. The position of the coronal splitting of the canals varied according to the root canal morphology.

The effect of a preparation containing glycocholic acid on the biocidal efficacy of sodium hypochlorite in a biofilm laboratory model.

This study assessed the antimicrobial effect of sodium hypochlorite (NaOCl) mixtures combined with Keratobacter (KB) using an engineered biofilm root canal model. Clinical and reagent grade NaOCl were mixed with KB (9:1-vol/vol) to assess pH values over 1 min to select the ideal solution with a pH just below the pKa of hypochlorous acid. The samples were randomly divided into five groups: 1% and 4% NaOCl reagents, a mixture of NaOCl:KB using 1% and 4% NaOCl reagents and distilled water. Outcome measures were colony-forming units (CFUs/mL) and positive/negative cultures. No significant differences were observed in the pairwise comparisons between 1%, 4% NaOCl and 4% NaOCl+KB for the outcome CFUs/mL. Only 4% NaOCl presented with negative cultures in all samples, whereas 1% NaOCl and 4% NaOCl+KB had similar results (54% vs. 40%). The addition of KB has a limited effect on the antimicrobial efficacy of 4% NaOCl in this laboratory model.

The supplementary use of XP-endo Finisher R after Reciproc enhances the removal of a bioceramic sealer in oval root canals.

This study compared the performance of Reciproc and Reciproc Blue endodontic files in retreatment time and re-establishment of apical patency, plus removal of a bioceramic sealer from the canal surface with the supplementary use of the XP-endo Finisher R. Following preparation, slightly curved oval root canals in mandibular incisors were filled using a corresponding gutta-percha point and a bioceramic sealer. Apical patency achievement was assessed and the time required to reach the original working length was recorded. The samples were split longitudinally and were photographed to assess the material remaining on the canal walls. No significant differences were observed regarding patency achievement or retreatment times when comparing Reciproc and Reciproc Blue. Significant less material remained on the canal walls when Reciproc was followed by XP-endo compared with Reciproc alone, and when the data for Reciproc and Reciproc Blue were pooled.

Regenerative Endodontic Procedure in an Immature Permanent Incisor with Internal Root Resorption: a Case Report.

This report describes a regenerative endodontic procedure of an immature permanent incisor with internal root resorption (IRR) and 4-years follow-up. A healthy 8-year-old man was referred for treatment of tooth #9 after a traumatic intrusion. The periapical radiograph showed an IRR and an open apex with periradicular lesion. A diagnosis of pulp necrosis and chronic apical abscess was achieved. In the first appointment, under local anesthesia and rubber dam isolation, an access cavity was designed and the root canal was chemically cleaned under irrigation with 10 mL 1.5% sodium hypochlorite (NaOCl). The root canal was then dried and calcium hydroxide paste was placed. During the second appointment, the root canal was irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 5 minutes and dried. The blood clot was established in a time of 3 minutes after the bleeding from the periapical tissue was trigged. White mineral trioxide aggregate (MTA) was placed up to the amelocemental junction and the final restoration of the access cavity was carried out. During periodic clinical and radiographic follow-up, the patient remained symptom free, the periapical region was completely healed, inhibition of the root resorption process achieved, and formation of the new periodontal ligament as well as tooth widening development observed, meeting functional expectations after 48 months. The regenerative endodontic procedures are an available option to treat IRR in severely immature teeth. The available literature on the regenerative endodontic procedures applied to IRR treatment is limited, and more research is needed in this field.

Effectiveness of XP-Endo Finisher and Passive Ultrasonic Irrigation in the Removal of the Smear Layer Using two Different Chelating Agents.

STATEMENT OF THE PROBLEM: The smear layer may harbor microorganisms and necrotic pulp tissue, jeopardizing irrigant penetration. Recently, Dual Rinse®, a weak chelating agent, has been introduced to the market. However, its chelating capacity in the final irrigation protocol with different activation systems has not yet been deeply analyzed. PURPOSE: The aim of this ex vivo study was to evaluate the effectiveness of passive ultrasonic irrigation (PUI) and XP-endo Finisher (XP) on smear layer removal in combination with two chelating agents, ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP). MATERIALS AND METHOD: This in vitro, experimental study evaluated fifty-two single-rooted human teeth were standardized to 16 mm in length. Root canal instrumentation was performed by the ProTaper Gold system up to the F4 file. The apical end of the samples was sealed with wax to simulate a closed system. Teeth from group 1 (n=24) were irrigated with 3% sodium hypochlorite (NaOCl) and 17% EDTA, while teeth from group 2 (n=24) were irrigated with 3% NaOCl mixed 9% HEDP. Both groups were divided into two subgroups (n=12) depending on the activation system used: XP (group XP-EDTA and XP-HEDP) or PUI (group PUI-EDTA and PUI-HEDP). The specimens were evaluated by scanning electron microscopy at 3, 5 and 8mm from the apex. Statistical analysis was performed using ANOVA and Bonferroni tests considering p> 0.05 as significant. RESULTS: PUI-EDTA was the most effective at removing the smear layer, with a statistically significant difference from XP-EDTA (p< 0.042) and group XP-HEDP (p< 0.003). There were no statistically significant differences among the other groups. CONCLUSION: Under the conditions of this ex vivo study, no activation system was able to completely remove the smear layer from the root canal walls. However, the combination of NaOCl with ultrasonically activated EDTA obtained better results than the other treatments.

Regeneración pulpar: una segunda oportunidad al diente inmaduro. A propósito de un caso / Regenerative endodontics: at second chance to immature apex. A case report

Desde la introducción del término revascularización en 1971, muchos han sido los protocolos descritos para el tratamiento de un diente inmaduro con necrosis pulpar y periodontitis apical. La complejidad que supone la realización de técnicas de apicoformación en dientes con raíces cortas, paredes frágiles, ápices no formados y divergentes, permiten que el tratamiento de endodoncia regenerativa esté indicado. El caso que presentamos a continuación se trata de un paciente de corta edad que acude a la consulta por presentar dolor en el cuarto cuadrante. Tras la anamnesis y pruebas complementarias, llegamos al diagnóstico de necrosis pulpar con periodontitis apical sintomática del diente 44. En la radiografía podemos apreciar la presencia de una raíz corta, con paredes frágiles y ápice no formado. Tras hablar con los padres del paciente decidimos optar por el tratamiento de endodoncia regenerativa. Discutiremos a lo largo del caso la técnica empleada durante la realización de este caso clínico, centrándonos en la desinfección del interior del sistema de conductos, y la posterior creación de una matriz de andamiaje necesaria para poder colocar nuestro material biocerámico. En el apartado de discusión acercaremos al clínico las distintas opciones presentes en la literatura para afrontar la desinfección, medicación intraconducto y material de sellado, pilares fundamentales para el éxito del tratamiento de endodoncia regenerativa. En el seguimiento del caso, el paciente se presenta totalmente asintomático, con un desarrollo radicular completo y una formación de las paredes que devuelven la integridad al diente inmaduro

Since the introduction of the term revascularization in 1971, there have been many specific protocols for the treatment of an immature tooth with pulp necrosis and apical periodontitis. The complexity of performing apexification techniques on teeth with short roots, fragile walls, and non-formed and divergent apices, allows regenerative endodontic treatment to be indicated. The case presented below is about a young patient who comes to the office for presenting pain in the fourth quadrant. After the anamnesis and complementary tests, we arrived at the diagnosis of pulp necrosis with symptomatic apical periodontitis of tooth 44. On radiography, we can detect the presence of a short root, with fragile walls and an unformed apex. After talking with the patient's parents, we decided to opt for regenerative endodontic treatment. We will discuss throughout the case the technique used during the realization of this clinical case, focusing on the disinfection of the interior of the duct system, and the subsequent creation of a scaffolding matrix necessary to be able to place our bioceramic material. In the discussion section we will approach the clinician the different options present in the literature to deal with disinfection, intra-conduction medication and sealing material, fundamental pillars for the success of regenerative endodontic treatment. In the follow-up of the case, the patient appears totally asymptomatic, with a complete root development and a formation of the walls that restore integrity to the immature tooth

The effect of a preparation containing glycocholic acid and/or agitation on the tissue dissolution ability of sodium hypochlorite.

This study assessed the porcine palatal mucosa dissolution, from artificial grooves, by a final rinse of sodium hypochlorite (NaOCl) solely or mixed with Keratobacter ((KB); or agitation) passive ultrasonic irrigation (PUI) or sonic activation (SA). Soft-tissue samples (n = 123) were weighed and placed inside root canal grooves in central maxillary incisors. The specimens were randomly divided into six test groups (n = 20): NaOCl 3% with or without KB and the irrigation dynamics: positive pressure (PP), SA or PUI. An EDTA intermediate rinse was included. Soft-tissue weights were measured subsequently. The NaOCl + KB_PUI group showed the highest mean weight reduction, whilst the NaOCl_PP group recorded the lowest. NaOCl + KB subgroups were associated with hastened reduction compared with NaOCl subgroups. NaOCl_PP presented with significantly lower weight reduction when compared with the remaining experimental groups. The addition of KB to NaOCl or its agitation enhances tissue dissolution ex vivo. The agitation of KB-containing mixtures offers no further benefits.

Etidronic acid and ethylenediaminetetraacetic acid associated with sodium hypochlorite have limited effect on the compressive fracture resistance of roots ex vivo.

AIMS: To assess the effect of etidronic acid (EA) mixed with sodium hypochlorite (NaOCl) and two ethylenediaminetetraacetic acid-containing preparations (EDTA and SmearClear) alternated with NaOCl, as a final rinse, on root fracture resistance to a compressive force. MATERIALS AND METHODS: Seventy-two premolar roots were randomly allocated to the following groups according to the irrigant solutions. For the EA group, 9% EA + 2.5% NaOCl were used throughout the assays (n = 21). The remaining groups received 2.5% NaOCl during and immediately after chemo-mechanical instrumentation. Intermediately, the roots received 17% EDTA (n = 19), or SmearClear (n = 16), or no irrigation (control) (n = 16) plus a final rinse with 2.5% NaOCl. The specimens were subjected to a vertical compressive force loaded at a crosshead speed of 0.02 mm/s parallel to the long axis of the root until fracture occurred. The results were compared statistically using the one-way analysis of variance for intergroup comparisons. RESULTS: The negative control presented with the highest values, whereas the SmearClear presented with the lowest values, though no significant differences were found when comparing the different groups (P = 0.82). CONCLUSIONS: The use of EA + NaOCl or two EDTA formulations in association with NaOCl does not affect the fracture resistance of previously chemo-mechanically prepared roots.

Comparison of the Volume of Root Canal Irrigant Collected by 2 Negative Pressure Needles at Different Flow Rates of Delivery.

INTRODUCTION: A greater irrigant volume improves the effectiveness of root canal irrigation. The purpose of this study was to compare 2 negative pressure systems regarding the volume of irrigant collected from the apical area in moderately curved canals at 3 different flow rates of delivery in vitro. METHODS: The mesiobuccal canals of 30 molars with a curvature between 20° and 40° were prepared to size #40.04 taper. A closed system was created. The canals were irrigated at 3, 6, and 12 mL/min for 30 seconds using EndoVac (SybronEndo, Orange, CA) and the INP needle (Mixnus Fine Engineering Co Ltd, Nagano, Japan) (both independent variables). A recovery trap was used to collect the irrigant aspirated by the negative pressure needles. Irrigant volume (dependent variable) was measured in milliliters. Data were analyzed using mixed analysis of variance. RESULTS: There was a statistically significant interaction between the negative pressure system and the irrigant volume collected (P < .0005). The mean irrigant volume collected by the different negative pressure systems was greater for INP at 3 (P < .001), 6 (P < .001), and 12 mL/min (P < .001) flow rate. Both negative pressure needles showed statistically significant differences (P < .001) between mean irrigant volume collected at different flow rates. CONCLUSIONS: A greater volume was collected by increasing the flow rate of irrigant delivery for both EndoVac and INP. The INP needle could collect a greater volume of irrigant from the apical third compared with EndoVac at all 3 different flow rates.

Sodium Hypochlorite and a Preparation Containing Glycocholic Acid and Surfactants Have a Synergistic Action on Organic Tissue Dissolution In Vitro.

INTRODUCTION: The aim of this study was to evaluate porcine palatal mucosa dissolution by sodium hypochlorite (NaOCl) with or without an auxiliary dissolving agent containing glycocholic acid and a mixture of surfactants (Keratobacter [KB]; Saint Joseph DID, Valencia, Spain). METHODS: One hundred forty samples were obtained from porcine palatal mucosa and weighed using a high-precision balance. The samples were randomly divided into 4 experimental groups (n = 35) based on the test solution used: distilled water (the negative control), CanalPro NaOCl 6% (Coltene Whaledent, Altstätten, Switzerland), KB, and a 9:1 vol/vol mixture of NaOCl with KB (NaOCl + KB). After 5, 10, 15, and 20 minutes of immersion in the solutions at 27°C ± 1°C, the samples were weighted by a blinded assessor. The intergroup weight at the different time points was statistically analyzed using the analysis of variance test with the Bonferroni posttest. RESULTS: All test groups presented with tissue dissolution although complete dissolution did not occur in any sample. The largest percent in weight reduction occurred between time points (t) = 0 minutes and t = 5 minutes for the NaOCl + KB group (22.5%) followed by KB (18.5%) for the same time period. NaOCl presented with similar tissue dissolution activity during the different time points, ranging from 7.8% (t = 10 minutes-t = 15 minutes) to 6.8% (t = 15 minutes-t = 20 minutes). Significant weight differences were found among the different experimental groups after 5, 10, and 15 minutes of incubation, with the only exception being KB versus NaOCl + KB. No significant differences were found when comparing the test groups at t = 20 minutes. CONCLUSIONS: The addition of KB to NaOCl increased porcine palatal mucosa dissolution in vitro.

Effect of Passive Ultrasonic Activation on Organic Tissue Dissolution from Simulated Grooves in Root Canals Using Sodium Hypochlorite with or without Surfactants and EDTA.

INTRODUCTION: The aim of this study was to evaluate the porcine palatal mucosa dissolution from artificial grooves using a final rinse with sodium hypochlorite (NaOCl) with or without a surfactant or ultrasonic activation (PUI). METHODS: The root canals of 130 human maxillary central incisors were chemomechanically prepared and the teeth split. A standardized longitudinal intracanal groove was created in 1 of the root halves. One hundred thirty porcine palatal mucosa samples were collected, adapted in order to fit into the grooves, and weighed. The reassembled specimens were randomly divided in 3 experimental groups (n = 40) based on their irrigation protocol (ie, positive pressure [PP] and PUI during 15 [PUI-15] or 30 seconds [PUI-30]) and divided in subgroups according to the NaOCl preparation used: Vista 6% plain (Vista Dental Products, Racine, WI) or Chlor-XTRA (Vista Dental Products) (containing surfactant). An EDTA intermediate rinse was included. Palatal mucosa weights were measured after the assays. The intergroup weight changes were statistically analyzed. RESULTS: Complete dissolution did not occur in any sample. Chlor-XTRA subgroups were associated with increased weight reduction compared with Vista 6% plain subgroups; however, the differences were significant (P < .05) only for PP and PUI-15. PUI-30 increased weight reduction compared with PP for both hypochlorites and PUI-15 using Vista 6% plain (P < .05). PUI-30 with Vista 6% plain performed significantly better than PP with Chlor-XTRA (P < .05). CONCLUSIONS: The addition of a surfactant to NaOCl and/or PUI activation increased palatal mucosa dissolution within artificial grooves in the root canal of incisor teeth. PUI agitation was often able to compensate for the absence of surfactants.

Utilidad del score air en el diagnóstico y pronóstico de apendicitis aguda / Utility of the score air in the diagnosis and prognosis of acute appendicitis

Antecedente: la apendicitis aguda (AA) es la causa más común de urgencias quirúrgicas en el mundo; se estima un riesgo de padecerla durante la vida del 7% y un número de apendicetomías negativas entre 5 y 10%. Objetivo: evaluar la validez del Score AIR (respuesta inflamatoria por apendicitis) como herramienta diagnostica en pacientes con sospecha de apendicitis aguda. Metodología: se realizó un diseño epidemiológico, analítico, transversal de período, en pacientes que acudieron al Hospital Dr. Gustavo Domínguez Z., con sospecha de apendicitis aguda, entre julio y diciembre de 2015, mediante la aplicación del Score AIR más correlación con hallazgos histopatológicos. Los datos fueron ingresados en el paquete estadístico SPSS versión 21 para su análisis. Resultados: el presente estudio incluyó 210 pacientes con sospecha de apendicitis aguda, 108 mujeres y 102hombres con una edad promedio de 24.4 años; a la validación con los hallazgos histopatológicos el Score presentó una S:98.47%, E: 61.54%, VPP: 97.48%, VPN 72.72%, RV+:2.56, RV-:0.024; las muestras analizadas fueron fases necróticas con 48.57% seguidas de fases supurativas; puntajes altos de AIR se relacionaron con fases avanzadas de apendicitis con un rango de evolución entre 16 y 24 horas y cifras elevadas de leucocitosis, neutrofilia y PCR mostraron relación directa con las fases complicadas de apendicitis. Conclusión: el Score AIR sirve como herramienta de diagnóstico y pronóstico de apendicitis aguda.

Background: Acute appendicitis is the most common cause of surgical emergencies in the world, the risk of suffering during the life of 7%, is estimated a number of negative appendectomies from 5 to 10%. Objective: To evaluate the validity of AIR Score as diagnostic tool in patients with suspected acute appendicitis. Materials and Methods: A design analytical epidemiological transverse period was made in patients who attended to Dr. Gustavo Dominguez Z. Hospital with suspected acute appendicitis, between July and December 2015, applying Score AIR more correlation with histopathologic findings. The data were entered into SPSS version 21 for analysis. Results: This study included 210 patients with suspected acute appendicitis, 108 women and 102 men with an average age of 24.4 years; the Score validation with histopathological findings presented a S:98.47%, E: 61.54%, VPP:97.48%, VPN 72.72%, RV+:2.56, RV-:0.024;samples analyzed were necrotic phases in 48.57% followed with suppurative phases; high AIR scores were associated with advanced stages of appendicitis range hours of evolution between 16 and 24 hours and high levels of leukocytosis, neutrophilia and PCR showed direct relationship with the complicated stages of appendicitis. Conclusion: AIR Score serves as a tool for Diagnosis and Prognosis of Acute Appendicitis

Cómo aplicar la medicina basada en pruebas: flujograma de 4 escalones / How to apply evidence-based medicine: 4-step flow chart

Se aborda de manera didáctica la temática sobre "medicina basada en pruebas ­evidencias­" (MBE), planteado a través del "flujograma de 4 escalones": 1. Pregunta (paciente, intervención, control, desenlace); 2. Búsqueda (bibliotecas virtuales); 3. Valoración crítica o lectura crítica (jerarquía de la evidencia, grados de recomendación, variedades de estudios, los 10 criterios de valoración crítica); y 4. Aplicabilidad (validez, importancia, aplicación). De igual manera, se presentan los conceptos epidemiológicos estándares que se usan para cuantificar los riesgos y beneficios de un tratamiento experimental: años-paciente, índice de incidencia, riesgo relativo (RR), reducción del riesgo relativo (RRR), número de pacientes a tratar (NNT), reducción del riesgo absoluto (RRA), y ­en los estudios observacionales­ odds ratio (OR).

It's exposed in a didactic way the theme on "evidence based medicine" (EBM), raised through "4 steps flux diagram": 1. Question (patient, intervention, control, outcome); 2. Search (virtual libraries); 3. Critical evaluation (evidence rank, grades of recommendation, the 10 criteria of critical evaluation); and 4. Aplicability (validity, importance, application). Similarly, we present the standard epidemiological concepts used to quantify the risks and benefits of an experimental therapy: patient-years, incidence rate, relative risk (RR), relative risk reduction (RRR), number needed to treat (NNT), absolute risk reduction (ARR). In observational studies, the odds ratio (OR).

Correlación entre marcadores inflamatorios y hallazgos histopatológicos en la apendicitis aguda / Correlation between inflammatory markers and histopathological findings in acute appendicitis

Antecedente:la apendicitis aguda (AA) es la causa más común de emergencias quirúrgicas agudas que requieren intervención quirúrgica; se estima que el riesgo de padecerla durante la vida es del 7 %. Objetivo:analizar el papel de la proteína C reactiva (PCR), recuento de glóbulos blancos (CWB ) y porcentaje de neutrófilos (PN) para optimizar la calidad del diagnóstico de apendicitis aguda y compararlo con los hallazgos histopatológicos. Metodología:se realizó un estudio prospectivo en 210 pacientes con diagnóstico clínico de apendicitis aguda que fueron intervenidos quirúrgicamente en los que se realizó hemograma y PCR durante el período prequirúrgico. Las muestras obtenidas en el transquirúrgico fueron analizadas mediante histopatología. Se realizó una correlación diagnóstica entre los marcadores proinflamatorios y los hallazgos operatorios y patológicos. Resultados: en los pacientes con apendicitis aguda complicada se observó: conteo de leucocitos mayorde 15(×109/l), porcentaje de neutrófilos mayor de 85% y PCR mayor de 10 mg/L. Cifras elevadas de PCR, WBC y PN fueron observadas en 102 pacientes(48.57%), tomando en cuenta que los valores de PCR mayores de 21.48 mg/L se relacionaron con estadios avanzados de apendicitis. El histopatológico mostró que las apendicitis de tipo gangrenoso fue la más frecuente(51% eran mujeres y 48% hombres); el rango de edad fluctuó entre 15 y 80 años (media: 24,4). Conclusión:la medición de la PCR mejora la precisión diagnóstica de apendicitis aguda, sobre todo si se suman los valores de leucocitos y porcentaje de neutrófilos. La PCR y la neutrofilia son marcadores inflamatorios de gran sensibilidad diagnóstica y pronóstica de apendicitis aguda.

Background:Acute appendicitis (AA) is the most common acute surgical emergencies requiring surgery cause a risk of suffering during the life of an estimated 7%. Objective: To analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of acute appendicitis diagnosis and to compare it with the histopathology findings. Methodology: A prospective study was conducted in 210 patients with clinical diagnosis of acute appendicitis who underwent surgery which underwent a blood test and PCR in the pre-surgical. The samples obtained in the transsurgical were analyzed by histopathology and subsequently correlated with the pro inflammatory markers was made. Results: In patients with appendicitis CRP and WBC were elevated in 126 patients (72.8%), while the NP and CRP were higher in 117 patients (67.6%) and CRP, WBC and PN were elevated in 116 patients (67.6%); taking into account that CRP values greater than 11.7 mg / dl and above 82% neutrophils correlated with advanced stages of appendicitis. Histopathological showed that gangrenous appendicitis were the most frequent type, 51% of patients were women and 48% were men, aged between 15 and 80 years with a mean of 24.4. Conclusion:Measuring PCR improves the diagnostic accuracy of acute appendicitis especially if the values of leukocytes and percentage of neutrophils are added. CRP and neutrophilic inflammatory markers are great sensitivity for the diagnosis and prognosis of acute appendicitis.

Incisivo lateral superior con doble reabsorción interna / A rare case of not perforating double internal root resorption

La reabsorción radicular podría ser clasificada en externa o interna dependiendo de la localización de la misma en relación con la superficie de la raíz afectada. La reabsorción interna es relativamente poco frecuente, y su etiología y patogénesis no esta todavía del todo clara. Este artículo muestra la complejidad de un incisivo lateral superior con una doble reabsorción radicular no perforante y la importancia de la CBCT para la confirmación tridimensional de la reabsorción dental, su diagnóstico y clasificación. Tiene gran importancia el examen de la radiografía preoperatoria y el de las realizadas durante el tratamiento. Desde una perspectiva de diagnóstico diferencial, la llegada de la CBCT ha mejorado considerablemente la capacidad clínica de diagnóstico de la reabsorción radicular interna. Sin embargo, hasta la fecha, el tratamiento de conductos sigue siendo el tratamiento de elección para este tipo de patologías pulpares. En el seguimiento del caso que se presenta, el diente muestra signos clínicos y radiográficos de salud a los 24 meses después del tratamiento

Root resorption might be broadly classified into external or internal resorption by the location of the resorption in relation to the root surface. Internal root resorption is a relatively rare occurrence, and its etiology and pathogenesis have not been completely elucidated. This article shows the complexity of upper lateral incisor with a double not perforating root resorption and the significance of CBCT imaging in the confirmation of the three-dimensional resorption of teeth. The importance of the preoperative radiographic examination as well as radiographs during treatment is necessary. From a differential diagnosis perspective, the advent of cone beam computed tomography has considerably enhanced the clinician’s capability of diagnosing internal root resorption. Nevertheless, root canal treatment remains the treatment of choice for this pathologic condition to date. The tooth was clinically and radiographically healthy at the 24-month follow-up

Root Canal Penetration of a Sodium Hypochlorite Mixture Using Sonic or Ultrasonic Activation

The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.

O objetivo deste estudo in vivo foi determinar, para os sistemas "abertos" e "fechados", se o design tem influência na penetração, em milímetros, do hipoclorito de sódio misturado com um meio radiopaco quando empregado na ativação com pressão positiva (PP) e ativação sônica (SI) ou ultrassônica passiva (PUI). Sessenta dentes unirradiculares foram divididos em dois grupos: sistema aberto e sistema fechado (n=30). Os canais radiculares foram trabalhados até um comprimento de trabalho de 17 mm. Os grupos foram subdivididos em três subgrupos (n=10) de acordo com a solução irrigadora e a ativação: PP, e ativação SI ou PUI. Usando radiografias, a distância de penetração foi medida e avaliado o vapor contido. Para o grupo fechado, as distâncias médias de penetração foram PP 15,715 (±0,898) mm, SI 16,299 (±0,738) mm e PUI 16,813 (±0,465) mm e houve vapor contido em 53,3% das amostras. No grupo aberto, houve penetração de 17 mm em 97.6% das amostras, sem contenção de vapor. A penetração do irrigante e avaliação da distribuição usando sistemas aberto e fechado produziram resultados significativamente diferentes. Para os sistemas fechados, PUI é mais eficaz para levar o irrigante até preencher o comprimento de trabalho, seguido por SI.

Root canal penetration of a sodium hypochlorite mixture using sonic or ultrasonic activation.

The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.

Instrumentación tridimensional de sistemas de conductos mediante el sistema self adjusting file (SAF). A propósito de un caso / Tridimensional instrumentation of root canal systems through self adjusting file (SAF). A case report

Algunas de las dificultades que nos encontramos en los retratamientos son la eliminación del material de obturación intraconducto y la presencia de dentina muy contaminada por microorganismos resistentes, en muchas ocasiones asociados en biofilms. En el caso que presentamos nos ayudamos en la última fase del retratamiento de un nuevo sistema que combina instrumentación e irrigación simultáneamente, cuya principal característica es la de adaptarse a la sección transversal de los conductos y de este modo permitir alcanzar áreas en las que la instrumentación rotatoria presenta grandes limitaciones. Facilitándonos, de este modo, la eliminación de cemento y gutapercha remanentes así como dentina contaminada, respetando la anatomía original. El caso ejemplifica esta técnica clínica sobre la que hemos realizado una discusión a partir de la literatura revisada. El diente tratado, un segundo molar inferior, presenta una periodontitis apical aguda producida por una subextensión del material obturador y una deficiente condensación del mismo. Su anatomía inusual formada por un único y amplio conducto es desobturada y desinfectada para proceder a su obturación termoplástica. La evolución del caso a los 6 meses indica una mejora de la sintomatología sin signos radiográficos que indiquen patología periapical (AU)

Some of the difficulties we can find in a retreatment are the removal of the filling material and the presence of intracanal dentin heavily contaminated with resistant organisms, often associated in biofilms. In this case report we help in the last phase of treatment that combines a new simultaneously instrumentation and irrigation system whose main characteristic is to adapt to the cross section of the canals and thus allow to reach areas in which the rotary instrumentation has great limitations. In retreatments, this system provide us thereby removing residual cement and gutta percha and most infected entin, respecting the original anatomy. The present case illustrates the clinical technique on which we have made a discussion from the literature reviewed. The treated tooth presents a acute apical periodontitis with a subextensión of the root canal treatment and a poor condensation. Its unusual anatomy consists of a single large canal which is desobturated and disinfected to proceed with thermoplastic seal. The evolution of the case at 6 months indicates an improvement of symptoms without radiographic signs of apical periodontitis (AU)

Root anatomy and canal configuration of the permanent mandibular first molar: clinical implications and recommendations.

Root canal anatomy may present clinicians with a complex clinical challenge that requires diagnostic approaches, access modification, and clinical skills to successfully localize, negotiate, disinfect, and seal the root canal system. This article discusses the clinical implications of endodontic therapy on permanent mandibular first molars. The number of roots on the mandibular first molar is directly related to ethnicity. Canal morphology has a significant effect on treatment protocol: Mesial roots present two canals on a regular basis, adopting 2-2 and 2-1 as the most common configurations. A third canal is present in 2.6% of the population. The most common configuration in the distal root is type I (62.7%), followed by type II (14.5%) and type IV (12.4%). Diagnosis and treatment of complex root canal systems often require specialized training that may be beyond the scope of the average general practitioner. Access modifications are required to find extra roots and/or canals. The instrumentation of the third root requires a different access and small, flexible instruments, given the curvature that is usually present buccally in the apical third. The incidence of isthmuses is 55% in the mesial root and 20% in the distal root. This anatomical configuration should be taken into consideration during endodontic treatment as well as during periapical surgery.

Herpes zoster-induced abdominal wall paresis: neurophysiological examination in this unusual complication.

BACKGROUND: Herpes zoster affects essentially sensory fibres with segmental distribution. Abdominal wall paresis is a rare complication. AIMS OF THE STUDY: We present the case of a 72 year-old man with herpes zoster infection in T11-T12 left dermatomes and segmental abdominal wall protrusion. METHODS: Electromyography (EMG) and dermatomal somatosensory evoked potentials (DSEPs) were performed 27 days after symptoms onset. RESULTS: EMG confirmed acute axonal lesion in left external oblique muscle and left paraspinal muscles at T11-T12 level and DSEPs assessed topographic distribution: there was no response in the left side at T12 dermatome. Three months following the onset of shingles, the abdominal wall protrusion had completely resolved. CONCLUSIONS: Neurophysiological examination, including EMG and DSEPs, confirms motor and sensory loss in this unusual post-herpetic complication.